Brain tumors in pregnancy. Management and outcome of four consecutive cases

Introduction Management of brain tumors is challenging and even more so during pregnancy. The incidence of brain tumors in pregnant and nonpregnant woman is similar (around 2.6 per 100,000 women). The most common histological tumor types diagnosed during pregnancy are glioma and meningioma ([Abb. 1]).

Abb. 1  

We report four cases of brain tumors in pregnancy and their perinatal and maternal outcome.

Material and Methods Between 2021 and 2023, four cases of brain tumors diagnosed during pregnancy were identified in our departmental database and maternal and perinatal outcomes were evaluated.

Results Details in [Table 1].

Tab. 1 Maternal and perinatal outcomes in four brain tumors diagnosed in pregnancy. Abbreviations: CS: cesarean section; G: Gravida; GA: gestational age; Gy: Gray; L: left; NICU: neonatal intensive care unit; NVD: normal vaginal delivery; P: Para; Perc.: percentile; UApH: umbilical artery pH.

Case	Age	G	P	Initial Symptoms	Diagnosis/Histological Type	Tumor Therapy	GA at delivery	Mode of delivery	Blood loss (ml)	Newborn Weight (Perc.)	Apgar	UApH	NICU
1	30	1	0	Anisocoria and diplopic images, ptosis	L medial sphenoid wing meningioma	Stereotactic radiotherapy (54 Gy)	35+6	NVD	1200	55	9/10/10	7,37	no
2	32	2	1	Status epilepticus	Astrocytoma of the L temporal lobe	Microsurgical anterior temporal lobectomy, radiotherapy (60 Gy) and chemotherapy CATNON protocol (temozolomide)	27+3	CS	1800	74	2/5/8	7,30	yes
3	35	7	4	Tonic-clonic seizure	Biopsy: Glioma L occipital region – final pathology report still due Li-Fraumeni syndrome	Tumor resection	30+0	CS	1440	46	8/9/10	7,43	yes
4	33	1	0	Recurrent tonic-clonic seizure	Right temporomesial and frontobasal oligodendroglioma	Radiotherapy (54 Gy) and chemotherapy (procarbazine, lomustin)	39+1	CS	500	94	3/5/9	7,22	yes

Conclusion Management of brain tumors during pregnancy requires a multidisciplinary approach and careful consideration of treatment options. In patients presenting with tonic-clonic seizures, eclampsia is an important differential diagnosis.

Through shared decision-making, personalized medicine, and advancements in surgical techniques, radiation therapy, and chemotherapy, healthcare professionals can navigate the complexities of brain tumor management while prioritizing the health and well-being of both mother and fetus. Ongoing research and collaboration in this field are crucial to further improve outcomes and provide hope for expectant mothers facing this challenging situation.

 

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Publikationsverlauf

Artikel online veröffentlicht:
15. November 2023